Back

Accumulator - View By Claim

Export to Excel

Health Center:
Pharmacy:
Capture Date :
To:


Health
Center
Pharmacy
ShipTo
Claim
Type
RX
Number
Member ID
Fill
Fill Date
Adjud
Date
Captured
Date
NDC
Drug
Name
Strength
Form
Pkg
Size
QTY
Disp
Curr
QTY
% of
Claim
Status
Status
Date
Order
Wholesaler
Invoice
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793024 MR002793580009/22/202209/22/202209/23/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 241003030100.00000Replenished 1002119666 3108617906
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793815 MR002232670010/27/202210/27/202210/28/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 241003030100.00000Replenished 1002129142 3111671677
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794407 MR002967620011/22/202211/22/202211/23/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 24100602033.33300Replenished 1002138927 3113726126
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794407 MR002967620011/22/202211/22/202211/23/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 24100604066.66700Replenished 1002141458 3114211042
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794470 MR002793580011/28/202211/28/202211/29/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 24100903033.33300Replenished 1002150980 3116568653
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794470 MR002793580011/28/202211/28/202211/29/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 24100906066.66700Replenished 1002141458 3114211042
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794588 MR003890110012/01/202212/01/202212/03/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 241006060100.00000Replenished 1002150980 3116568653
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795080 MR002793580003/03/202303/03/202303/04/202364980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 24100904044.44400Replenished 1002185066 3125534406
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795080 MR002793580003/03/202303/03/202303/04/202364980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 24100905055.55600Replenished 1002187584 3126302342
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795665 MR000820700001/24/202301/24/202301/25/202364980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 241009090100.00000Replenished 1002167601 3121067798